2
“Learning Experiences” Prisoner submits a Sick call request for low back pain. Seen by provider, diagnosed with chronic low back pain, given Tylenol. 2 weeks later, Patient complains of increased back pain, submits new kite every day for a week. Never seen in person, the paper triage disposition is “you have already been seen for this” Patient becomes a man-down, sent to ER where he is diagnosed with an acute abdominal aneurysm and died.

10
Clinical Case Prisoner submits sick call request for leg and back pain. Paper triage done, patient never evaluated, triage given a “routine” appointment which meant 3 week wait. Prisoner begged housing nurse and officers to have him seen, they responded with “submit a sick call”. Prisoner collapsed 2 days later, found to have totally necrotic leg from necrotizing fasciitis. Sent to ER, prisoner underwent a hemipelvectomy, ended up in hospital for a long time, huge bills, ultimately died, family sued for deliberate indifference, won several million dollars.

11
Keys to Performing Triage / Experienced Nurses / Encourage intuitive skills / Empower Nurses to use the skills they have been taught / Support Nursing with appropriate ancillary staff, you will loose the efficiencies of your nurses if you turn them into HUC’s / Experienced Nurses / Encourage intuitive skills / Empower Nurses to use the skills they have been taught / Support Nursing with appropriate ancillary staff, you will loose the efficiencies of your nurses if you turn them into HUC’s

15
Building a 5 Tier System / Level 3= Stable patient, chief complaint does not fall into nursing’s ability to care for with a nursing intervention, and is not in queue for a clinician follow up.

16
Building a 5 Tier System / Level 4= Stable patient who will need multiple resources prior to appointment. These can be administrative or diagnostic in nature.

17
Building a 5 Tier System / Level 5= Nursing interventions. Chief complaint can be treated by implementing a nursing care plan or a verbal order by a clinician.

18
Content of a good assessment / Talk with each and every inmate who has a completed sick call request (kites). / Face-to-face contact--Illogical and improper to base your healthcare delivery system on the written skills of a 4th grader (AT BEST) describing their problem / Obtain complete vital signs--all 5!!! / Focus assessment on chief complaint / Assign a priority for provider scheduling / Triage cannot be re-prioritized unless prisoner is seen face-to-face / Talk with each and every inmate who has a completed sick call request (kites). / Face-to-face contact--Illogical and improper to base your healthcare delivery system on the written skills of a 4th grader (AT BEST) describing their problem / Obtain complete vital signs--all 5!!! / Focus assessment on chief complaint / Assign a priority for provider scheduling / Triage cannot be re-prioritized unless prisoner is seen face-to-face

31
Avoiding Pitfalls / It is imperative that you see & talk with the inmate / It is imperative that a complete set of vital signs be documented / There is no right or wrong answer / Prioritize scheduling to the best of your ability / Practice brings confidence, confidence brings refined skills / It is imperative that you see & talk with the inmate / It is imperative that a complete set of vital signs be documented / There is no right or wrong answer / Prioritize scheduling to the best of your ability / Practice brings confidence, confidence brings refined skills